IBS (Irritable Bowel) ABX a possibility, new research

My radar antennae goes on when I see a doctor working with a pharmaceutical company... however, I also wouldn't be surprised if many IBS cases were caused by bacteria, just as many peptic and duodenal ulcers are.

And of course - yet again - there's no one thing/magic bullet that helps everyone. (Not every peptic ulcer or duodenal ulcer for instance is caused by bacteria from what I've read, as an example)

But of course again, peptic ulcers, IBS, and many other things have been written off at least in part to 'overload of stress' etc...

just like CFIDS/FM...

I still think there is a viral/bacterial presence along with genetic susceptibilities for most if not all of these mysterious diseases...

IBS is a condition of the intestinal tract that causes symptoms of bloating, gas, abdominal cramping, diarrheadiarrhea, and constipationconstipation.

Xifaxan, now approved for the treatment of travelers' diarrhea, kills bacteria living in the gut. Experts disagree over the cause of IBS. Some suspect the root cause to be overgrowth of gut bacteria.

One of these experts is Mark Pimentel, MD, director of the gastrointestinal motility program at Cedars-Sinai Medical Center in Los Angeles. In prior studies, Pimentel used breath tests to show that about 80% of IBS patients may have serious bacterial fermentation going on in their gut.

This led him to wonder what would happen if he used a powerful antibiotic to shift the balance between overgrowth of these theoretically harmful bacteria and normal bacteria living in the gut.

So Pimentel and colleagues gave a 10-day course of Xifaxan or inactive placebo to 87 IBS patients. Seventy-two patients finished the study. As is common in IBS studies, those who got placebo felt a bit better. Those who got Xifaxan reported even more improvement -- especially less bloating.

"Xifaxan was superior to placebo for control of IBS," Pimentel tells WebMD. "It suggests we are finally tackling a sustainable cause of IBS. If it is bacteria, we have changed the environment so that IBS is better on a semipermanent basis."

The study, funded by Xifaxan maker Salix Pharmaceuticals, appears in the Oct. 17 issue of Annals of Internal Medicine. Pimentel is a consultant to Salix and has received speaking fees from the company. Cedars-Sinai Medical Center has a licensing agreement with Salix.

Change of IBS Treatment?
Is Xifaxan a new treatment for IBS? Not yet. A larger study, looking at IBS patients treated by their own doctors with Xifaxan, is already underway. Until those results are known, Xifaxan is not an officially approved treatment for IBS.

But Pimentel says he's treated "thousands" of IBS patients with Xifaxan -- and he says now the word is getting out.

"The gem here is you have a sustained effect in IBS. The larger, longer studies will show how well this works," he says. "We've reported these results at professional meetings, and it has changed the way IBS is treated. Sixty percent of gastroenterologists in the country are starting to do it this way."

Pimentel says the average patient needs re-treatment every two or three months, but that response varies greatly from patient to patient.

Controversy Over IBS Treatment
Not all experts are convinced that bacterial overgrowth is a root cause of IBS, or that antibiotics are the best treatment. One of these experts is Douglas A. Drossman, MD, co-director of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.

In an editorial accompanying the Pimentel study, Drossman notes that IBS is a complex disorder that springs from the complex interplay of an oversensitive gut and the brain.

Breath tests, he says, aren't reliable for diagnosing bacterial overgrowth. And Pimentel's study, he says, does not prove that treating bacterial overgrowth helps.

Drossman is not impressed by Pimentel's finding that IBS patients reported an average 36.4% improvement in the 10 weeks after treatment with Xifaxan, while those given placebo treatment reported an average 21% improvement.

"Only bloating improved, and abdominal pain, diarrheadiarrhea, and constipationconstipation did not improve," Drossman notes. "The benefit of using antibiotics is not fully proven and must be balanced with potential risks in terms of side effects, high costs … and the need for recurrent treatment."

Pimentel says new studies now coming out will support the bacterial-overgrowth theory of IBS. He does, however, say people with IBS have "movement disorders of the small bowel." He is hoping that a drug to promote movement in the small bowel will improve outcomes for IBS patients treated with antibiotics.

PS you know if I had IBS and found out that abx would help me but had to take it yearly or whatever to keep it away... I think it would be worth it - don't see how that's a downside as long as you can tolerate the abx and take probiotics etc...

It amazes me when an important post like this gets ignored!!! I saw an article in the Sun. paper today and came online here hoping to find a lively discussion about this. Was shocked to find your post buried so far down already.

I have heard about this doc and his research for at least a year now. I am glad they are doing some controled studies now on this. The 36.4% improvement is not that dramatic, but it is encouraging. I know when I take the antibiotic Amoxicillan for a sinus infection, my IBS-D always clears up. My son also notices his IBS-D clears up when he is on antibiotics. But, we both also notice that it eventually always comes back. I personally would not like to keep taking antibiotics and I wonder if they also wipe out the good bacteria along with the bad. The article was not clear on that. I believe it would be very important to replace the good bacteria after a course of antibiotics and I wish they would do some research on which bacteria would specifically work for this.

There was a recent thread on colon bactereia and it's strong link to CFS. I will look for it and try to bump it.

I'm sure the abx does wipe out the good bacteria... one would I think have to balance taking probiotics halfway between doses of abx to help keep a balance.. and maybe even eventually pulsing probiotics in between pulsing abx.

I'm wondering too if there could be more than one strain... My son does better using different abx for lyme... makes sense to me.